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HIV/AIDS

'We can't get there with just science alone'

Despite reported progress toward a promising HIV vaccine, the decrease in infection rates has slowed in some parts of the world. Access to treatment needs to improve, says "AIDS 2014" co-chair Sharon Lewin.

December 1 marks World AIDS Day. But are we any closer to a preventative vaccine for HIV, the virus that causes AIDS? Scientists in Canada, led by Dr. Chil-Yong Kang, report success in their human trials for a preventative vaccine, but a commercially available vaccine is still many years off. Some fear that the hype around vaccines and media reports of so-called miracle recoveries are detracting from the immediate problems.

Sharon Lewin, a professor of infectious diseases at the Alfred Hospital and Monash University in Melbourne, Australia, conducts research into latent or dormant HIV cells, which could also lead to a vaccine. However, Professor Lewin warns that we should not let the search for a vaccine get in the way of antiretroviral treatment.

DW: You recently attended the International Congress on AIDS in Asia and the Pacific in Bangkok. Can you describe the mood at that meeting?

Sharon Lewin: The overall theme for the conference was 'getting to zero', and I think the overall mood was that we're nowhere near it, especially in Asia. There was some quite worrying data presented showing ongoing increasing infections in key affected populations.

So while we're seeing the global number of new infections decreasing, which is great news, there were still 2.5 million new infections in 2012. And in Asia in fact there has been very little decrease in new infections. In some populations, like men who have sex with men, transgender women, people who inject drugs, prisoners, the data is showing increasing incidents. So I think the overall mood was we need to do something different to reduce new infections.

Blood draw (photo: JON HRUSA/EPA)

Access to test facilities and treatment is crucial in reducing infection rates, Lewin says

Why aren't infection rates falling? What can we do differently?

I think one of the big factors that is leading to a global reduction in infection rates is increasing access to treatment, because if you're on treatment, it not only improves the health of the person taking the anti-virals, it also reduces their infectiousness. So if you have more people on treatment in a population, it will reduce the amount of virus circulating. And that seems to have an impact in what we call generalized epidemics, where you've got HIV at higher rates across the whole population. But if people are marginalized or discriminated against, they're not getting tested, and they're not accessing healthcare services, those interventions won't work.

I think the problem in a lot of these communities within the Asia Pacific and even in Australia, is that many people don't know that they're infected, and even those that know they're infected aren't engaged in staying in care, so therefore you've got ongoing transmission.

The fall of infection rates in some African countries is also slowing. What's the danger of media reports of so-called miracle recoveries or news about human trials for preventative vaccines clouding the necessity to keep up active good treatments, such as antiretroviral treatments, as well as awareness?

I think the messaging is difficult, because on the one hand, there have been some incredible gains and successes in the HIV response and we have seen that by declines in deaths and declines in new infections. But on the other hand, HIV has certainly not gone away. And with 2.5 million new infections just last year, there are still a lot of people out there getting HIV, still 35 million people living with HIV. We can't let the guard down. We need to constantly educate, constantly make prevention tools available, make it easy for people to get tested and access care, and change laws that marginalize populations.

A very interesting statistic that came out in the UN AIDS report was that in countries that had a higher than ten percent prevalence of HIV in people who inject drugs, those countries spent the lowest on harm reduction strategies. It's obvious, but a very simple thing like making clean needles available will have a huge impact on the transmission among people who inject drugs.

A boy holds a banner as he walks in an anti-AIDS rally observing World AIDS Day in Calcutta, India (photo: ddp images/AP Photo/Bikas Das)

There were some 2.5 million new infections in 2012

You are co-chair of the International AIDS Conference in Melbourne in July next year. We often hear that it can sometimes be policy that gets in the way of good science and good common sense in the community. How do you feel about bringing together both scientists and policy makers?

I think this conference is a wonderful vehicle to deal with those issues, because you do have scientists and clinicians and policy makers and advocates and communities and world leaders and celebrities all meeting together.

With HIV, although science has made incredible contributions, we can't get there with just science alone - a lot of it is around implementation. For example, we have excellent anti-HIV drugs, we have more and more ways to prevent HIV but the challenge is getting those drugs into communities, making them easily accessible, keeping people on treatment and keeping people in care, and we know we don't do that so well. So the real challenge now is implementing the science that we already know works.

Professor Sharon Lewin is a professor of infectious diseases at the Alfred Hospital and Monash University in Melbourne, and co-chair of AIDS 2014, the international AIDS conference taking place in Melbourne next July.

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